Tuberculosis comeback

A new strain of tuberculosis that does not respond to drug treatment is spreading, particularly in the Asia-Pacific region. Doctors are warning that Australia can't ignore the problem as tuberculosis may no longer be a disease of the past.

Transcript

ALI MOORE: In many Western countries tuberculosis is regarded as a disease belonging to another era, but doctors are warning Australia can't afford to think it's a scourge of the past. Recent figures show there were more than nine million new cases diagnosed worldwide in 2006, and more than 1.5 million people died. What's even more worrying is the spread of a TB strain that doesn't respond to drug treatment, and is now at record levels, particularly in the Asia Pacific region. Natasha Johnson reports.

DR JOHN CARNIE, VICTORIAN CHIEF HEALTH OFFICER: This is absolutely no time for complacency, even for countries where TB has basically disappeared from the radar. TB is still around. ASSOC. PROF. PAUL JOHNSON, INFECTIOUS DISEASES, AUSTIN HEALTH: If we let the situation get out of control and then react to it, there'll be deaths and infected people.

NATASHA JONES: These are the faces of what the World Health Organisation has declared a global emergency. Featured in a photographic exhibition at Parliament House, they have tuberculosis, a disease that many Western nations thought was a curse of the past. TB engendered fear in previous generations of Australians as a third who contracted it died, a third became chronically ill, while a third recovered.

ASSOC. PROF. PAUL JOHNSON: There was an epidemic of TB and we lost hundreds of thousands of people.

NATASHA JONES: Tuberculosis can occur in any part of the body, but most commonly infects the lungs causing a chronic cough, sometimes with blood, which spreads the bug around. And that's how respiratory physician Dr Rob Pierce caught the disease while treating TB patients 25 years ago.

DR ROB PIERCE, RESPIRATORY PHYSICIAN, AUSTIN HEALTH: I felt chronically unwell and rundown and more tired than usual. It was a scary feeling if you like, being in isolation.

NATASHA JONES: Free chest x-rays on street corners, isolation and campaigns against spitting were the only defence until the antibiotic revolution offered a cure. Now there's a new threat; drug resistant TB. How frightening are these drug resistant strains of TB?

ASSOC. PROF. PAUL JOHNSON: Well, I'm scared of them.

NATASHA JONES: The TB bug is hard to kill, requiring a cocktail of drugs over six months to cure. But strains that have built up resistance take much longer.

DR IVAN BASTIAN, INST. MEDICAL & VET. SCIENCE: The treatment requires up to 24 months of treatment. It requires treatment with a whole range of antibiotics that are often very toxic and also very expensive. It costs nearly $60,000 to treat one case of MDR TB.

NATASHA JONES: The World Health Organisation has just reported that multi drug resistant TB is now at record levels in 81 countries, amounting to almost half a million new cases each year with the highest rates in the Asia Pacific region. There were 22 drug resistant cases in Australia in 2006, and one of a virtually untreatable strain called extensively drug resistant TB.

ASSOC. PROF. PAUL JOHNSON: You really have to look the patient in the eye and say, "We'll do our best but if you do get sick, I'm not sure we do have anything for you".

NATASHA JONES: Drug resistance has emerged in developing countries where a resurgence of TB was triggered by the HIV AIDS epidemic and then antibiotic treatment was mismanaged.

DR IVAN BASTIAN: It's really a man made problem. It's because patients are put onto treatment, they may not be fully supervised, they might take lower doses, they might miss doses.

NATASHA JONES: 85 per cent of Australia's TB cases are in migrants, but travelling to an infected country can also be a risk. Twenty four people at a Sydney school recently tested positive after a staff member was diagnosed on returning to Australia. While migrants and long term visitors must undergo chest x-rays, they only pick up patients who are actually sick at the time.

ASSOC. PROF. PAUL JOHNSON: And this was the migration x-ray that was taken when he left his country of origin and it's actually completely normal. Now this x-ray is taken about seven months later and it's the same patient, believe it or not, and you can see this huge white mass.

NATASHA JONES: The problem is that only 10 per cent of people who are infected become sick and infectious with what's called active TB, and there's no way of knowing who will and wean in their lifetime.

ASSOC. PROF. PAUL JOHNSON: A third of the world has latent TB, they're dormant and sleeping and they can wake up at any time in the future.

NATASHA JONES: Australia has only 1200 TB cases annually, one of the lowest incidences in the world. But infectious diseases doctor Paul Johnson from Austin Health believes services need expanding.

ASSOC. PROF. PAUL JOHNSON: Maybe 10, 20 per cent of more recently arrived migrants may be carrying this. We need to be ready and we don't need to be winding down and mothballing our services.

NATASHA JONES: How well prepared are we?

ASSOC. PROF. PAUL JOHNSON: I think at the moment we're just hanging on.

DR JOHN CARNIE: They're doing an excellent job, which is evidenced by the fact that the resistant rate is so low in Australia. It's not true to say they're only just hanging on. They're doing a good job, but clearly we need to be vigilant.

NATASHA JONES: Ivan Bastian, a microbiologist on the national TB advisory committee says Australia's first line of defence is overseas, with colleague Richard Lumb, his laboratory is supporting countries in the region.

DR IVAN BASTIAN: If we don't control TB around the world, then we're not able to control it forever here in Australia.

DR JOSEPH BANA-KOIRI, RESPIRATORY PHYSICIAN: I feel like we are fighting a losing battle.

NATASHA JONES: At a recent conference in Brisbane PNG's leading TB doctor, Joseph Bana Koiri, told how his country is hopelessly ill equipped to deal with drug resistant TB.

DR JOSEPH BANA-KOIRI: It's nearly only a 50 per cent chance of curing them, but when you've got somebody giving them a chance and you run out of drug supply it's nearly a, you feel like crying.

NATASHA JONES: A third of Australia's recent drug resistant cases came from PNG, and free movement through the Torres Strait poses a risk to northern Queensland Aboriginal communities which already have a high incidence of TB generally.

BOB MCMULLEN, PARLT. SEC. INTERNATIONAL ASSISTANCE: It's a very big issue for us. We are specifically addressing how we can do more in that area of the Torres Strait.

NATASHA JONES: As well as bilateral efforts, the World Health Organisation's Peter Van Maaren is calling on Australia to double its $93 million contribution to the global fund to fight TB.

BOB MCMULLEN: We have a proposal that wouldn't be a doubling, but it would be about a 40 per cent increase.

NATASHA JONES: 95 per cent of TB still responds to drug treatment, and it's critical these cases are properly treated so that more drug resistant strains don't develop.

DR JOHN CARNIE: The risks of having the spread of drug resistant forms of TB will make TB a virtual incurable disease and that is a scenario that nobody wants to look at.